Remedial Clinical Documents

Click and download or print the forms, complete the form by entering information requested in each form clearly, do this for all forms, sign all forms, mail all forms to our office (address at bottom of this page). Include copies of your ID/Driver license, SS Card, Insurance card, CPR card. Note: we are no longer accepting forms by email, please mail all your documents to the school address. 
Note that form #4.2 must be taken to a healthcare provider for completion and signature.

Required: immunization records – Physical, HEP B, MMR, Varicella titers, TB Screening.
Others: Background Check, Professional Liability insurance-on campus, Driver’s License, SS Card, proof of health insurance, AHA BLS CPR

A. Click here to order your Polo Shirt Clinical Female Polo  | Clinical Male Polo

B. Print & Sign Payment Plan Policy. Click here for first part Payment $850.00

C. Uniform For Live class Navy Blue Scrubs top & bottom, OR Royal Blue scrub top & bottom with clean shoes. Please do NOT mix the colors, wear same color each day.

Number 5. Read & sign the Clinical Instructions

Number 6. List of all documents you will need for clinical – Course Requirements^

Number 7.  4-1. ROPHEM-PHYSICAL EXAM Form-Pg 1

Number 8. 4-2. ROPHEM-PHYSICAL EXAM Form-Pg 2 (must be completed by MD, PA, D.O., APRN)

Number 9. VECHS-Private-School-Waiver-Agreement-and-Statement-Form(1)

Number 10. Background Check ORI instructions

Number 11. Hepatitis B Vaccine Declination Form

Number 12. Acknowledgement of Risk and Release of Liability

Drug testing – Do this within one month before clinical start date – DRUG TESTS 

Use COUPON CODES below to get the courses free.
First: Go to Rophem CE Courses website and SIGN UP.
Create your username & password.
Second: Locate the courses on that website.
Basic HIPAA Course – code REMHIPAA
Elder Abuse, Neglect & Exploitation Course – code REMABUSE
Print your certificate after completion of the course and submit a copy to the Rophem Nursing Office.

Be sure to read and be familiar will all Remedial Theory and Clinical Policies.

Rophem Nursing Academy
3530 1st Ave North, Suite 201
St Petersburg, FL. 33713.

To your Success!


**Remedial Course Step by Step to completion – 12 weeks total.
Step 1 – After 100.00 deposit – Complete Forms & Payment (half or full) – Number 1 to 4
Step 2 – Complete Required Clinical Documents – Number 5 to 12
Step 3 – Create your online account. Start Theory – Live or Online
Step 4 – Submit all clinical documents & pay balance if applicable – due 2 weeks before clinical
Step 5 – Start Clinical Training based on group/dates selected.
Step 6 – Complete course, Pass all exams & Mock/Readiness Exams
Step 7 – Completion Letter sent to BON via email.